GOOD SHEPHERD HOME

Official classification

Type B

Official code

87608(a)(5)(A)

Regulation authority

CCR

What the official deficiency says

Postural Supports. Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet. A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed. This requirement is not met as evidenced by: Based on observation, resident (R1's) bed had split bed rails, (R2's) bed had a three-quarter length bed rails, and underneath resident (R3's) bed a three-quarter length bed rail was observed. Physician orders are in place for half length rails only. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Staff agreed to remove one of the split bed-rails in R1's bed, remove R2's three-quarter length bed rail and place a half length rail, and obtain a half length bed rail for R3, and remove the three-quarter bed rail underneath the resident's bed. *Note: R1- R3 have written order from a physician indicating the resident’s need. Submit picture evidence that residents (R1-R3's) beds have half length bed rails.

Deadline recorded: Nov 11, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(28)

Regulation authority

CCR

What the official deficiency says

General Food Service Requirements. The following food service requirements shall apply: All food shall be protected against contamination. Contaminated food shall be discarded immediately upon discovery. This requirement was not met evidenced by: On 9/29/25, Regional Center specialist observed wilted lettuce, strawberries with mold, and food containers with mold in the kitchen refrigerator. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee stated the expired food was immediately removed and a plan of action was put in place the following day (9/30/25). 1. Administrator agreed to submit proof of staff training. 2. Plan of Action and logs were provided today. Licensee shall inspect all food storage areas and discard all expired cans. Licensee shall submit a written statement, that all expired cans were discarded and will monitor food supply frequently. Submit self-certification by POC due date.

Deadline recorded: Nov 11, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(a)

Regulation authority

CCR

What the official deficiency says

General Food Service Requirements. The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner. On 9/29/25, Regional Center specialist observed that 7-day non-perishable food pantry had 15 items that were expired. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee shall ensure staff inspect all food storage areas and discard all expired cans. Licensee provided a copy of the plan of action put in place 9/30/25, food supply will be checked weekly and staff will sign a log. 1. Submit proof of staff training.

Deadline recorded: Nov 11, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303(a) Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidence by: Based on interview and observation, resident bedroom #4 had a hole in the ceiling, one of the walls in bathroom #1 was chipped at the bottom and bathroom vent was dirty which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee completed repairs prior to today's visit by covering/reparing the hole in bedroom #4, reparing the chipped wall in bathroom #1 and cleaning the vent in bathroom #1.

Deadline recorded: Jul 8, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(b)(13)

Regulation authority

CCR

What the official deficiency says

87506(b)(13) Resident Records (b) Each resident’s record shall contain at least the following information: (13) Continuing record of any illness, injury, or medical or dental care, when it impacts the resident's ability to function or needed services. This requirement is not met as evidence by: Based on interview and record review, licensee did not ensure that residents had the proper declination of routine medical appoinment in place and scheduled resident dental appoinment accordingly which poses a potential risk for the health and safety of residents in care.

Official plan of correction

Corrections made during time of visit. Licensee provided LPA with declination for medical services for resident and scheduled dental appoinment via phone call for resident for 8/1/25.

Deadline recorded: Jul 8, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(5)

Regulation authority

CCR

What the official deficiency says

87555 General FoodService Requirements (b) The following food service requirements shall apply: (5) Meals shall consist of an appropriate variety of foods and shall be planned with consideration for cultural and religious background and food habits of residents. This requirement is not met as evidence by: Based on record review, current menu plan for residents does not offer a variety of foods to meet personal preferences, special dietary needs, food habits and cultural background which poses a potential health and safety risk for residents in care.

Official plan of correction

Licensee will create a menu plan with alternative food choices to meet the needs of resident's food habits, preferences and cultural background. Licensee will include a variety of foof items for residents in care by POC due date.

Deadline recorded: Jul 22, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87470(c)

Regulation authority

CCR

What the official deficiency says

(c) An Infection Control Plan shall be developed by the licensee and shall be included in the Plan of Operation required by Section 87208. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as there is no infection control plan on file which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/03/2023 Plan of Correction Licensee/Administrator to provide Licensing with an Infection Control Plan for review by POC due date.